Provider Demographics
NPI:1417960865
Name:STEPHENS, JAMES T III (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:T
Last Name:STEPHENS
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5375 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9239
Mailing Address - Country:US
Mailing Address - Phone:270-443-7200
Mailing Address - Fax:270-443-8527
Practice Address - Street 1:3001 SCHNEIDMAN RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3541
Practice Address - Country:US
Practice Address - Phone:270-443-7200
Practice Address - Fax:270-443-8537
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7577OtherSTATE LICENSE#